Efficacy of radiosynoviorthesis on clinical outcomes in persons with haemophilia. A systematic review and meta-analysis

PURPOSE: This systematic-review and meta-analysis investigated the effectiveness of radiosynoviorthesis (RSO) on clinical outcomes in male persons with haemophilia (PwH) and evaluated the quality of existing evidence. METHODS: Literature searches in PubMed and Web of Science identified 31 studies, with 17 included in the meta-analysis. Random-effects models were computed to analyse RSO-related changes in bleeding frequency, pain, synovial hypertrophy, and orthopaedic joint score. Due to insufficient data, Range of Motion (RoM) changes could not be meta-analytically calculated. Mean differences (MD) for bleeding frequency and standardized mean differences (SMD) for the remaining outcomes were computed. RESULTS: Results showed significant reductions in bleeding frequency at six months (MD = -5.93 [95 %-CI: -7.80, -4.06], p < 0.001, k = 10) and twelve months (MD = -7.83 [95 %-CI: -12.11, -3.55], p < 0.001, k = 6). Six months post treatment, pain (SMD = -1.31 [95 %-CI: -2.25, -0.38], p = 0.006, k = 5), synovial hypertrophy (SMD = -0.50 [95 %-CI: -0.65, -0.36], p < 0.001, k = 4), and orthopaedic joint score (SMD = -0.61 [95 %-CI: -0.92, -0.30], p < 0.001, k = 4) showed moderate to large improvements. Average RoM changes were minimal (2.6 % improvement). The overall complication rate was 12 per 1000 treated joints. CONCLUSION: Despite promising results, the overall quality of evidence was moderate to low due to high methodological heterogeneity and lack of control groups. These findings suggest RSO is a safe and effective treatment for key clinical outcomes in PwH, but further well-designed controlled trials are needed to confirm these results.